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Tapping into controversial back surgeries

Look up a Surgeon

This database allows you to find and compare spinal fusion operating rates of surgeons nationwide. To start, enter a doctor's last name in UPPER CASE. If the number of patients that they operated on comes up blank, it was between 1 and 10 (Medicare redacted those counts to protect patient privacy). You can also download this spreadsheet with more detailed information. It can be sorted by total fusions and filtered by city or state.

The data includes procedures performed on Medicare patients from 2011-2012. Some of the country's highest volume surgeons discounted its value. They questioned the validity of the numbers and told us (for reasons listed below) that the data should not be used to compare them with their peers. Other doctors said it could be hugely beneficial to patients.

Dr. Sohail Mirza, Chair of Orthopaedics at Dartmouth-Hitchcock Medical Center, said if your surgeon performed significantly more of these fusions than others in your community, or did them on a far higher percentage of their patients, you should ask them why. You may also want to get another opinion. It could just mean they have a sizeable referral base because they are respected in the field, but it could also mean that they are doing surgeries that others would not consider appropriate.

We asked Medicare for details on the billing codes for spine surgery and the agency referred us to the American Medical Association, which forwarded us to the North American Spine Society (NASS). One of NASS's billing experts helped us identify the codes most commonly used for spinal fusions that treat degenerative conditions that cause lower back pain. Experts told us to focus on this subset of fusions because it is more controversial, and there is a debate over whether some of them are necessary.

NASS's expert then helped us develop a methodology for counting these surgeries. Specifically, any time CPT code 22558, 22585, 22586, 22612, 22614, 22630, 22632, 22633, or 22634 was billed, it was counted as one spinal fusion surgery. If multiple codes were billed on the same procedure, it was still counted as one surgery. When fusing more than two vertebrae, there are separate "add-on" codes to be billed once per additional vertebra, according to NASS. Any time CPT code 22585, 22614, 22632, or 22634 was duplicated (billed twice) on the same procedure, it was counted as a fusion on four or more vertebrae.

We did not count surgeries where the physician was described as an assistant or team surgeon, or didn't finish the procedure, by excluding codes with modifiers 53, 55, 66, 73, 74, 80, 81, 82, AK, or AS. Doctors that did not have the specialty codes for neurosurgeons, orthopedic surgeons, or physical rehabilitation specialists were also removed from the dataset.

We sent the instructions to the Centers for Medicare and Medicaid Services (CMS). Michael Marquis, Christopher Powers, and Stephanie Bartee at CMS compiled a large spreadsheet with roughly 192,000 fusions by 6,000 doctors. It was the first time Medicare had released spinal fusion data and allowed the names of surgeons to be made public. No patient information was disclosed, and as stated above, counts between 1 and 10 were redacted to protect patient privacy. National averages were calculated among doctors that performed more than 10 total fusions. Fusions on beneficiaries in Medicare's Part C program were not included as those plans are run by private insurers.

Limitations to the data

The billing codes used to compile this database describe a technique - not a diagnosis. According to NASS, they are most commonly used for treating degenerative conditions, but may also be used for other purposes.

The billing codes do not indicate whether a fusion was inappropriate, and some widely accepted fusions (like those for spondylolisthesis, or a slipped disc) are billed for using these codes.

Billing can be confusing and there may be inconsistencies among surgeons in terms of the codes they use for fusions. There may also be billing errors.

Some surgeons may get more referrals, see more complicated cases and do more fusions as a result. These numbers do not take into account the severity of the conditions the surgeon is treating.

Since this just covers Medicare patients, physicians in areas with large elderly populations have higher numbers.

Some of these fusions may include the mid-back or neck, as some of the codes used extend up to that area.

Some surgeons often perform "360 degree" fusions, which involve two surgeries (through the front and back). Their total number of fusions may be higher as a result, but the number of patients that they fused is not changed by this.

Some spine surgeons operate on other parts of the body as well. They may have lower numbers and bring down averages.

Residents, physician assistants, and others under a surgeon's supervision can file claims under that doctor's name. While this is not done for spinal fusion surgeries, it may artificially increase the number of patients that a doctor saw in the data.

To calculate averages for fusions on four or more vertebrae, we used 10 for each doctor with a redacted count. This was done to avoid overstating the differences between doctors performing many of these fusions and their peers.

As with all large datasets, there may be miscellaneous errors.

Incorrect address?

If you are a surgeon and your state (or full address in the spreadsheet) is incorrect, check the information you provided to the National Provider Identifier registry. If you have recently changed it, email us at spinesurgeons@cbsnews.com and we will update your information in the database.